Chapter 4 90 clinicians, questionnaires were filled out on illness management, clinical, functional, and personal recovery. This study was conducted in accordance with the Declaration of Helsinki. The RCT was approved by the medical research ethics committee (MREC) at Erasmus MC Rotterdam (Netherlands) and accredited by the Dutch Central Committee on Research Involving Human Subjects (CCMO), and was registered under number NTR 5033 in the Dutch National Trial Register (28). Measures Illness management constituents Coping was assessed using the client-rated Coping Self-Efficacy Scale (CSES). As the 26 items of the CSES are rated on a scale of 0–10, total scores range from 0–260, with higher scores indicating higher self-efficacy for coping with challenges and threats. The CSES consists of three factors: using problem-focused coping (12 items); stopping unpleasant emotions and thoughts (9 items); and getting support from friends and family (5 items) (32). Social support was assessed using the clientrated Multidimensional Scale of Perceived Social Support (MSPSS), whose 12 items are rated on a scale of 1–7. Total scores therefore range from 12–84, with higher scores indicating higher perceived social support. The MSPSS has a three-subscale structure: family, friends, and significant others (33). Medication adherence was assessed using the treatment-adherence-subscale of the clinician-rated Service Engagement Scale (SES). As the four items of this subscale are rated on a scale of 0–3, possible total scores of the subscale range from 0–12, with higher scores indicating higher medication adherence. The total SES (14 items) includes four subscales: availability, collaboration, help seeking, and treatment adherence (34). Psychiatric insight was measured using the client-rated Insight Scale (IS), which captures three dimensions of insight: perceived need for treatment, awareness of illness, and re-labelling symptoms as pathological (35). Total scores range from 0– 12, with higher scores indicating better insight (36). Problems with a.) alcohol, or b.) drugs were assessed using one client-rated item (item 24) from the Addiction Severity Index (ASI). As the two sub-items of this item are each rated on a scale of 0–4, possible total scores range from 0–8, with higher scores indicating more substance-related problems. The ASI is a semi structured interview designed to provide an overall assessment of the severity of problems in seven potential problem areas in substance-abusing patients: medical status, employment and support, drug use, alcohol use, legal status, family/social status, and psychiatric status (37–38).
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